In the letter, the “Love Can Build a Bridge” singer, 72, and physician Daniel R. Weinberger, M.D. discuss how “suicide is actually one of the leading causes of preventable death among these mental illnesses.”

Every year, almost 45,000 people give up hope and commit suicide, a painful act we stop to ponder every September during National Suicide Prevention Awareness Month. In 2018, we witnessed several high-profile celebrity suicides and staggering new data – a 30 percent rise in the number of people taking their own lives since 1999. These numbers pale in comparison to those left bereft by suicide — often called “suicide loss survivors” — making it more critical than ever to shine a spotlight on this highly stigmatized mental health concern.

In June, the U.S. Department of Veterans Affairs (VA) released data showing that veteran suicide numbers are significantly higher than non-veterans and are not declining. These reports have set off alarms on social media, with numerous blogs and Facebook testimonials highlighting people’s struggles with depression, and others sharing the loss of family members and friends.

The statistics in America are shocking. The Centers for Disease Control and Prevention (CDC) reports that the suicide rate increased to 13.7 per 100,000 people age 10 and older, and the U.S. Department of Veterans Affairs’ (VA) newest numbers find that veterans aged 18-34 have a suicide rate more than twice as high as non-veterans, meaning that every day 20 veterans choose to end their own lives. With 45,000 Americans deciding to end their lives every year, suicide is now the 10th leading causes of all deaths in the United States, and the CDC considers it a leading public health threat.

For everyone mourning the death of someone who committed suicide, an inevitable question arises: Why did this happen? Unfortunately, we don’t have very good answers. We do know that suicidal behavior accompanies many behavioral brain disorders such as schizophrenia, bipolar disorder, and depression. Suicide is actually one of the leading causes of preventable death among these mental illnesses. Addiction is another common brain disorder in people who commit suicide with around 40 percent having abused alcohol and about 25 percent having a history of illicit substance abuse. But even here, we know that we lack complete answers. When the CDC released their latest numbers, they noted that almost half the people who died by suicide did not have a diagnosed mental illness.

Currently a disproportionate amount of research focuses on suicide as a sociological and psychological phenomenon, but the latest studies on aggression and impulsivity may give us better answers. The website BuzzFeed has a video with almost 7 million views where a man named Kevin Hines talks about how he attempted suicide by jumping from the Golden Gate Bridge. “The millisecond my hand left rail, I felt instant regret,” Hines says. He then adds, “I thought to myself, ‘No one will know I didn’t want to die.’”

Mr. Hines’ explanation fits with current scientific thinking that the majority of suicides occur as impulsive acts of aggression, with the brain functioning in an altered state. Many suicides happen impulsively and are usually successful if the person has easy access to lethal means such as firearms, poisons, a means of self-hanging, or hazardous heights. When researchers have studied people who died by suicide —interviewing family members and physicians, and studying medical records, in a process called a psychological — they have found those who completed suicide tended to have higher levels of aggression.

It is also clear from many studies that suicide runs in families and has some genetic roots. In fact, studies of twins show that 43 percent of the likelihood of committing suicide is determined by one’s genes. While it remains unclear which specific genes contribute to risk of suicidal behavior, family studies have consistently found that suicidal behavior is partially explained by transmission within families of impulsive and aggressive traits. And relatives of suicide completers have been found to have elevated levels of impulsive-aggressive traits and are themselves more likely to have histories of suicidal behavior.

To understand this issue better, we have to bring the study of suicide into mainstream neuroscience and treat the condition like every other brain disorder. People who commit suicide are experiencing problems with mood, impulse control and aggression, all of which involve discrete circuits in the brain that regulate these aspects of human experience, but we still don’t understand how these circuits go haywire in the brains of suicide victims.

Most likely the propensity for specific malfunctions in the relevant brain circuitry began to form early in development, perhaps even inside the womb. With other brain disorders such as schizophrenia, bipolar disorder, and depression, we have an increasingly rich landscape of research delving into the biology and genetics of these diseases, but nothing yet at this level for suicide. We do know, for example, that lithium seems to reduce the likelihood of suicide attempts, but we do not understand the biological mechanism for why this is so.

Refocusing suicide research necessitates public and private collaborations. Right now about six times as many people in the United States die by taking their own lives as do from HIV/AIDS or heart disease, but the money to study suicide is lacking. In a recent column for the New York Times, Dr. Richard Friedman highlighted this funding disparity, noting that heart disease researchers receive 29 times the amount of federal funds than suicide and suicide prevention scientists. In fact, the federal government spent more money last year to study dietary supplements than to understand why Americans decide to take their own lives.

“Nobody can understand it unless you’ve been there,” the singer, one half of Grammy-winning mother-daughter duo The Judds, previously told PEOPLE. “Think of your very worst day of your whole life – someone passed away, you lost your job, you found out you were being betrayed, that your child had a rare disease – you can take all of those at once and put them together and that’s what depression feels like.”

The illness took hold soon after The Judd’s Last Encore tour ended in 2012, leaving her feeling empty. Into that void, long-suppressed memories of childhood trauma re-emerged, including sexual abuse by a great-uncle.

During her depression, “I literally couldn’t leave the house for weeks. I was completely immobilized and every single second was like a day,” said Judd, who had to install an elevator in her home because her legs became so weak from lack of exercise. “It’s so beyond making sense but I thought, ‘Surely my family will know that I was in so much pain and I thought they would have wanted me to end that pain [through suicide].’”

Stopped only by the thought of a family member finding her body, the singer slowly found effective ways to heal: new medications, new therapies, stronger relationships with friends and family, including daughters Ashley and Wynonna, alternative treatments like massage and acupuncture.

“I’m still recovering myself,” said Judd. “I’m still trying desperately trying to help myself. There’s never going to be a pill for it all. I read up on all the scientific literature, I go to courses. I try so hard to stay up on everything that I possibly can to get rid of this horrible curse.”

“Those thoughts of suicide don’t come anymore. But I’m vulnerable. I know I can backslide,” she added.